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# Ceftriaxone
## Overview
Ceftriaxone is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered intravenously or intramuscularly.
## Primary Indications
* Treatment of various bacterial infections including, but not limited to, pneumonia, meningitis, gonorrhea, skin and soft tissue infections, urinary tract infections, intra-abdominal infections, and sepsis.
* Prophylaxis in certain surgical procedures.
## Adult Dosing
* **General Infections:** 1 to 2 grams IV/IM every 12 to 24 hours. Doses of 4 grams per day have been used in severe infections.
* **Meningitis:** 2 grams IV every 12 hours.
* **Uncomplicated Gonorrhea:** 500 mg IM as a single dose. For disseminated gonococcal infection, 1 gram IV/IM every 24 hours for 7 days.
* **Surgical Prophylaxis:** 1 to 2 grams IV/IM as a single dose within 30 to 60 minutes before the start of surgery.
* **Maximum Daily Dose:** Typically 4 grams per day, but higher doses may be used in specific severe situations under expert guidance.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Specific protocols should be consulted.
* **General Infections (non-neonatal):** 50 to 100 mg/kg/day IV/IM divided every 12 to 24 hours. Maximum 2 grams/day.
* **Severe Infections (non-neonatal):** Up to 100 mg/kg/day IV/IM divided every 12 hours. Maximum 4 grams/day.
* **Meningitis (non-neonatal):** 100 mg/kg/day IV divided every 12 hours. Maximum 4 grams/day.
* **Neonates (<7 days old or <2000 g):** 25 to 50 mg/kg/day IV/IM divided every 24 hours.
* **Neonates (>7 days old or >2000 g):** 50 mg/kg/day IV/IM divided every 12 hours.
## Dose Adjustments
No dose adjustment is required for renal impairment. Ceftriaxone is significantly eliminated by hepatic metabolism and biliary excretion. In severe hepatic impairment, monitoring may be considered.
## Contraindications
* Hypersensitivity to ceftriaxone, other cephalosporins, or penicillins.
* Neonates (gestational age ≤41 weeks) receiving IV calcium-containing solutions or infusions due to risk of precipitation in the lungs and kidneys.
## Adverse Effects
Common: Diarrhea, rash, injection site reactions, eosinophilia, thrombocytosis.
Less Common: Nausea, vomiting, abdominal pain, leukopenia, neutropenia, phlebitis, elevated liver enzymes, headache, dizziness.
Rare: *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures, biliary pseudolithiasis, hemolytic anemia, renal failure.
## Key Drug Interactions
* **Calcium-containing solutions/infusions:** Avoid concomitant administration, especially in neonates, due to risk of fatal precipitation. Separate administration by at least 48 hours.
* **Probenecid:** May increase and prolong ceftriaxone levels.
* **Warfarin:** Ceftriaxone may enhance the effect of warfarin, leading to increased INR. Monitor INR closely.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *C. difficile*-associated diarrhea.
* Monitor liver function tests and complete blood counts, particularly with prolonged therapy.
* Monitor renal function if co-administered with nephrotoxic agents.
* For neonates receiving ceftriaxone, careful monitoring for precipitation is crucial.
## Clinical Pearls
* Ceftriaxone has a long half-life, allowing for once or twice-daily dosing for most infections.
* Can be administered IM without dilution or with lidocaine.
* IV administration should be over 30 minutes or given as an intermittent infusion.
* Biliary pseudolithiasis (sludge) can occur, especially in pediatric patients; this is usually reversible upon discontinuation of the drug.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for definitive patient management.*
